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    Taking a closer look at oral propranolol as first-line treatment in infantile hemangioma

    Oral propranolol is prescribed for the most serious cases. In this Lancet review, experts highlight some considerations for treatment.

     

    REFERRING PATIENTS

    Noting that infantile hemangiomas are the most common soft-tissue tumors of infancy, with a prevalence of 4% to 5% in the overall infantile population, the article advocates close follow-up in the first weeks of life to identify at-risk hemangiomas, because 80% of all hemangiomas reach their final size by 3 months of age.

    The most likely triggering factor is hypoxia responsible for the activation of the HIF-1 alpha pathway.

    Precursor lesions are either present at birth or develop during the early neonatal period as a pale area of vasoconstriction or a telangiectatic red macule.

    “Ideally, a patient with infantile hemangioma who is at risk of complications should be referred to a multidisciplinary team for evaluation and for specific diagnostic measures,” the authors write. These measures include MRI and screening for hypothyroidism or coagulation abnormalities.

    There are also several scores to access severity, such as the Hemangioma Severity Scale and the Hemangioma Dynamic Complication Scale.

    Other beta-blockers like nadolol, atenolol and acebutolol have also been shown to be effective in treating infantile hemangioma. And because these beta-blockers are hydrophilic and not do cross the blood-brain barrier as does propranolol, they may also be associated with a lower risk of central nervous system (CNS) side effects such as disturbed sleep; bronchospasm and hypoglycemia.

    NEXT:  Oral propranolol in practice. Some considerations.

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